Positive Effects Of Platelet-rich Plasma Research Articles

The Biological Effect of Platelet-Rich Plasma on Rotator Cuff Tears: A Prospective Randomized In Vivo Study.

The positive effect of platelet-rich plasma (PRP) on tendon metabolism has been extensively investigated and proven in vitro. Additionally, in vivo animal studies have correlated the application of PRP with the enhancement of tenocyte anabolic activity in the setting of tendon degeneration. However, less is known about its in vivo effect on human tendon biology. The purpose of the current prospective randomized comparative study was to evaluate the effect of PRP on torn human supraspinatus tendon. Twenty consecutive eligible patients with painful and magnetic resonance imaging (MRI)-confirmed degenerative supraspinatus tendon tears were randomized in a one-to-one ratio into two groups. The patients in the experimental group (n = 10) underwent an ultrasound-guided autologous PRP injection in the subacromial space 6 weeks before the scheduled operation. In the control group (n = 10), no injection was made prior to surgery. Supraspinatus tendon specimens were harvested from the lateral end of the torn tendon during shoulder arthroscopy and were evaluated under optical and electron microscopy. In the control group, a mixed cell population of oval and rounded tenocytes within disorganized collagen and sites of accumulated inflammatory cells was detected. In contrast, the experimental group yielded abundant oval-shaped cells with multiple cytoplasmic processes within mainly parallel collagen fibers and less marked inflammation, simulating the intact tendon structure. These findings indicate that PRP can induce microscopic changes in the ruptured tendon by stimulating the healing process and can facilitate a more effective recovery.

Effects of vitrification solution supplemented with platelet-rich plasma in rat ovarian tissue cryopreservation.

The subject of this study was to investigate the utility of platelet-rich plasma (PRP) in the cryopreservation process to reduce cryodamage and increase tissue viability. Twenty-one female Wistar rats were randomly allocated to three groups. In Group 1 (G1), rats were not subjected to vitrification (n = 7). Group 2 (G2) was the vitrification group in which PRP was added to the basic vitrification solution (n = 7). Group 3 (G3) was the vitrification group in which fetal bovine serum was added to the basic vitrification solution (n = 7). Warmed tissues were evaluated with histochemical (HC) and immunohistochemical (IHC) staining, the TUNEL method, immunofluorescence (IF) staining, and biochemical analyses. The percentages of IHC staining, TUNEL method positivity, and IF staining were significantly higher in G2 compared to both G1 and G3 (P < 0.05). G2 ovaries exhibited a significant increase in both malondialdehyde and catalase values in comparison to G1 (P < 0.05). In HC staining, degenerations in primary and secondary follicles and in ovarian tissue were more common in the PRP-supplemented group. The calcium used in PRP activation was suspected to have increased the degeneration and prevented the possible positive effects of PRP. To the best of our knowledge, PRP-supplemented vitrification solution was used for the first time in the literature in this study in whole rat ovarian tissue vitrification. If PRP is to be used as a component in vitrification solution for rat ovarian tissue, the use of lower amounts of calcium or different methods in PRP activation, or the use of nonactivated PRP, should be considered from the beginning.

Platelet Therapy and Ovarian Rejuvenation in Women with Premature Ovarian Failure

Introduction: Premature Ovarian Failure (POF) is a disease that occurs before the age of 40 due to dysfunction of the ovaries. In these women، the production and secretion of estrogen hormone is not done properly. Such a situation causes irregular or interrupted periods، disturbances in the ovulation process and occurrence of menopausal symptoms. Premature ovarian failure makes it difficult for women to get pregnant، so more research in this field is necessary.&#x0D; Conclusion: The results showed that one of the recommended ways to repair and regenerate the failing ovarian tissue was the use of platelet-rich plasma (PRP). The positive effects of PRP were dependent on the high concentration of growth factors in the alpha granules of platelets. The results of this review article showed that the use of platelet-rich plasma in restoring ovarian function could be considered as a treatment method in these patients.&#x0D;

Advances in the Clinical Application of Platelet-Rich Plasma in the Foot and Ankle: A Review.

Autologous and recombinant biologic substances have been generated as a result of the research into the cellular features of the healing process. Orthobiologics are increasingly being used in sports medicine and musculoskeletal surgery. Nevertheless, clinical data are limited; consequently, further studies are required, particularly in foot and ankle pathologies. This review aims to provide evidence of the most recent literature results and ignite the interest of orthopedic specialists eager for an update about the most current discussion on platelet-rich plasma (PRP) clinical applications in the foot and ankle fields. Previous studies have shown that platelet-rich plasma can be beneficial in treating various conditions, such as chronic foot ulcers, osteoarthritis, Achilles tendinopathy, etc. Despite the positive effects of PRP on various musculoskeletal conditions, more prospective studies are needed to confirm its effectiveness at treating ankle and foot pathologies. In addition to clinical trials, other factors, such as the quality of the research and the procedures involved, must be considered before they can be used in patients. More long-term evaluations are needed to support or oppose its application in treating foot and ankle disorders. We present the most extensive review of PRP's clinical applications in the foot and ankle field.

Positive Effect of Platelet-Rich Plasma on Neoureterocystostomy in Rats: An Experimental Study.

Some of the most common problems after kidney transplant are urologic complications, including ureterocystoanastomosis leakage and stenosis with the development of severe renal graft complications. Isolated plasma contains active substances that cause the activation of various growth factors for the processes of tissue repair or regeneration, has an anti- inflammatory effect, activates angiogenesis, and reduces the risk of infectious complications. Platelet-rich plasma is actively used to stimulate bone regeneration, heal wounds and ulcers on the skin, enhance reconstruction of the larynx and trachea, and ameliorate urethral damage, among other uses. This study was developed to evaluate the positive effect of platelet-rich plasma on the healing process of an anastomotic wound in a model of ureterocystoanas-tomosis in rats. We randomized 14 Wistar albino male rats into 2 groups: group 1 included 7 rats that received platelet-rich plasma after ureterocystostomy; group 2 was the control group and included 7 rats that underwent ureterocystostomy without platelet-rich plasma. On postoperative day 7, all animals were euthanized, and the anastomosis area was resected for determination of the tissue hydroxyproline levels and histopathology examination. Tissue hydroxyproline levels were 767 ± 62.9 μg/g in group 1 and 256 ± 28.0 μg/g in group 2. Tissue hydroxyproline levels were significantly higher in group 1 compared with group 2 (P < .05). There were no significant differences in epithelial damage, acute inflammation, or fibrosis between the tissue samples of both groups. The results of this study show that the use of platelet-rich plasma during ureterocystostomy produces a positive effect. Our further research will be devoted to the use of autologous platelet-rich plasma in ureterocystostomy in big models.

Application of Platelet-rich Plasma (PRP) with Different Scaffolds in Tissue Engineering

Background: Today, stem cells are the best candidates for cell therapy and tissue engineering. Adipose-derived Stem Cells (ADSCs) are an essential source of cells in replacement therapies of many diseases. Objectives: This study compared the proliferation of ADSCs in alginate and fibrin scaffolds. Methods: Adipose-derived stem cells were isolated from adipose tissue and cultured in alginate or fibrin scaffolds with a medium containing PRP 10% or FBS 10%. Then, the cell viability percentage was assessed by MTT assay and trypan blue staining. Also, the percentages of living, apoptotic, and necrotic cells were assessed by flow cytometry assay on the fourth and eighth days. Results: The cell viability rate was significantly higher in the fibrin scaffold group with PRP than in other groups on the fourth and eighth days (P &lt; 0.05). Moreover, the rate of necrotic cells was significantly lower in the fibrin scaffold group than in the other groups (P &lt; 0.05). Besides, the percentage of living cells was significantly higher in the fibrin scaffold group with PRP than in the other groups on the fourth and eighth days (P &lt; 0.05). Also, the percentage of early apoptotic cells was significantly lower in fibrin with PRP than in other groups on the fourth day. There was no significant difference in the rate of late apoptotic cells between the groups (P &gt; 0.05). Conclusions: These findings indicate the positive effect of PRP on the survival and proliferation of ADSCs compared with FBS. Therefore, PRP can be considered a suitable supplement to replace animal sera like FBS.

WITHDRAWN: Prophylactic use of platelet-rich plasma for post-spinal low back pain following gynecological surgery: a randomized clinical trial

Post-spinal back pain is suggested to occur as a result of a localized inflammatory response that is often associated with some degree of muscle spasm. We aimed to evaluate the effect of platelet-rich plasma (PRP) in reducing the incidence of post-spinal back pain. One hundred patients were randomly enrolled and scheduled for elective gynecological surgery under spinal anesthesia. After the subarachnoid block, group A (placebo) received 2 mL of sodium chloride 0.9% injected into the track of spinal needle during its withdrawal (2 mm after outward withdrawal in muscles and subcutaneous tissues). While patients in group B (PRP); received 2 ml of PRP injected into the track of the spinal needle during its withdrawal. The primary outcome was the number of patients who developed post-spinal low back pain within the first week following the subarachnoid block. Secondary outcomes included the time of the first analgesic request and total meperidine consumption during the first 24 h postoperatively. Fifteen patients in the PRP group developed low back pain during the first week following subarachnoid block compared to 26 patients in the placebo group (p = 0.037). There was a significant decrease in the mean meperidine consumption during first 24 h postoperatively in PRP group (174 ± 14 mg) compared to placebo group (210 ± 22 mg) (p < 0.0001). Also, the first analgesic request was significantly delayed in PRP group (243 ± 21 min.) compared to placebo group (185 ± 31 min.) (p < 0.0001). This study demonstrated the positive effects of platelet-rich plasma on the prevention of post-spinal backache.

Оценка регенеративного потенциала плазмы, обогащенной тромбоцитами, при уретропластике в экспериментальной модели

Reconstructive plastic surgery is the gold standard in the treatment of primary urethral strictures, but the effectiveness of these methods does not reach 100%. In cases of recurrent urethral strictures, the effectiveness of standard operations is lower than with primary strictures, which requires a search for methods to improve the results of surgical treatment. To evaluate the structure of the intercellular matrix, the cellular composition and regenerative potential of a plasma enriched in platelets after performing urethroplasty on a biological model. Experiment was carried out on male rabbits ("Burgundy" breed) weighting 3.0-4.5 kg (18 individuals). 18 animals were divided into two groups: an experimental one (contained 9 individuals) and a control one (contained 9 individuals). All animals in each group were subjected to end-to-end plastic surgery of the urethral bulbous region using standard procedures. In the control group 4 ml of 0.9% NaCl isotonic solution was injected along the perimeter of the suture into anastomotic zone of the spongy body. Autologous plasma was injected to the animals from the experimental group. Histopathological examination was made by using routine pathological assessment with hematoxylin-eosin staining. The study also assessed the distribution and orientation of collagen fibers with Van Gieson stain. In order to objectively detail inflammatory and regenerative changes an additional immunohistochemical analysis was performed for the following antibodie groups: CD79a, CD43, CD31 (PECAM1), MMP1, MMP9. Quantitative analysis of structural changes was carried out by counting B- and T-lymphocytes having a positive membrane reaction with CD79a and CD43, respectively, in 10 representative sites in view (HPF) with a lens aperture of 0.65 in the highest concentration areas ("hot spots"). The expression level of MMP1, MMP9 was estimated by counting positive cells in 10 representative sites in view with a lens aperture of 0.65 in the submucosal and muscle layers. The level of angiogenesis in micropreparations was evaluated by counting the number of vessels in 10 sites in view (objective aperture of 0.65), reliable endothelial visualization was performed using CD31 expression (PECAM1). In the analysis of histological material use of platelet-rich plasma in the suture zone helps to reduce the area of necrotic changes and the inflammation severity, accelerated migration of macrophage-histiocytic cells to the alteration site and increased blood supply due to enhanced angiogenesis. In experimental samples a higher expression of metalloproteinases (collagenases) types 1 and 9, decreased collagen production and the correct orientation of collagen fibers during repair processes were noticed. The use of platelet-rich plasma helps to accelerate the reparative processes in the spongy body after urethroplasty. Another important positive effect of platelet-rich plasma is an increase in the expression of metalloproteinases, which leads to a decrease in collagen production and the correct orientation of collagen fibers. This allows to reduce the amount of pathological fibro-scar tissue in the operation area.

Platelet-rich plasma Applications in molar retention and dental cyst surgery

Introduction: Dental retentions and cysts are common pathology necessitating proper surgical treatment. During the recent decade, platelet-rich plasma has increasingly been used in oral surgery. Aim: Our aim was to illustrate its application alone and in combination with autologous bone or collagen in patients after odontectomy for dental retenion and cystectomy for dental cysts. Materials and Methods: A total of 53 patients, 28 males and 23 females, with retained molars or dental cysts were diagnosed and surgically treated between May 2017 and May 2019. Odontectomy was carried out in 36 pateints and cystectomy - in 21 ones. According to an original protocol of platelet-rich plasma preparation, it was applied alone in 21, along with autologous bone - in 14, and combined with collagen - in 19 patients. Results and Discussion: The comparison with a sex- and age-matched control group without such applications demonstrated certain advantages in terms of the positive effects of platelet-rich plasma on wound healing, pain perception and bone regeneration. Conclusion: Further research is needed to more comprehensively assess the benefits of these growth factors in oral surgery.

The Effect of Platelet-Rich Plasma on the Temporomandibular Joint After Radiotherapy in Rabbits.

Platelet-rich plasma (PRP) was administered into the temporomandibular joint (TMJ) space, which had been exposed to radiotherapy (RT), in an attempt to prevent and/or treat the late-term complications associated with RT when used for the treatment of head and neck cancers (nasopharyngeal cancer in particular) on the musculoskeletal system. A total of 13 adult male New Zealand ( Oryctolagus cuniculus) rabbits were used in the study. The animals were classified into 3 groups: 6 in the RT group, 6 in the RT+PRP group, and 1 in the control group (exposed to neither). The TMJ space of each rabbit was exposed to 2240 cGy external RT in total, and PRP was administered into the TMJ space 1 month later. The joints were surgically removed 1 month later and examined histopathologically. In the group given RT+PRP, the level of inflammation, amount of muscle fibrosis, vascular wall fibrosis, synovial membrane and condyle cartilage thickness, temporal extrabone fibrous cell layer count, and intramuscular changes were similar to those recorded in the control group, although the positive effects of PRP were not found to be statistically significant. The findings of the present study demonstrate that injections of PRP may increase joint inflammation and therefore enhance blood supply, resulting in the onset of regeneration. These favorable effects of PRP may be helpful in the fight against late-term musculoskeletal complications of RT and may minimize such side effects as sore jaw, malnutrition, and weight loss.

Efficacy of Autologous Platelet-Rich Plasma alone or in Combination with a Lotion Containing Growth-Factor like Polypeptides and Taurine in the Treatment of Androgenic Alopecia: A Randomized, Prospective, AssessorBlinded Trial

Introduction and objectives: Autologous Platelet-Rich Plasma (PRP) dermal injections are considered as a therapeutic option for the medical treatment of androgenic alopecia (AGA). However, clinical efficacy of this approach in some cases could be disappointing. Positive effects of PRP in AGA seem to correlate, at least in part, with a growth factors mimicking action. A hair scalp lotion containing high-purified, growth factors-like polypeptides (octapeptide 2, acetyl decapeptide 3, oligopeptide 20 and copper tripeptide) with the addition of glycine and taurine (GFM-L) is available. So far, no data regarding the potential synergistic effect of autologous PRP treatment combined with GFM-L are available. We therefore conducted a prospective, randomized, assessor-blinded trial to compare the efficacy and tolerability of PRP alone vs. PRP and GFM-L treatment in men and women with AGA. Materials and methods: The study was a prospective, randomized (with a balance ratio of 2:1), assessor-blinded, 3- month trial. Thirty subjects (18 men and 12 women; mean age: 41 years) were enrolled after their written informed consent. Twenty subjects were allocated to PRP treatment cycle followed by GFM-L application for 3 months (2 ml of lotion every other day) (Group A) and 10 subjects were allocated to PRP treatment alone (Group B). In both groups autologous PRP injections on the affected area were performed over a period of 3 months at interval of 3-4 weeks, using a volume of 10 cc of PRP for each session treatment. Primary end point was the Investigator Global Assessment (IGA) score of clinical efficacy at month 3 in comparison with baseline. IGA score ranged from 0 (no improvement) to 3 (strong improvement). Secondary endpoint was the evolution of Hamilton scale grading (HSG), evaluated at baseline and at the end of study period. IGA score and HSG were performed by an investigator unaware of the treatment allocation group. Results: All the enrolled subjects concluded the study period. At baseline HSG was 2.0 ± 0.6 in Group A and 2.1 ± 0.3 in Group B. At month 3, a significant reduction of HSG was observed in Group A subjects only, both in comparison with baseline and in comparison, with Group B values (1.3 ± 0.5 vs. 2.1 ± 0.37; P=0.0028). At month 3, IGA score was 2.1 ± 0.9 in group A and 0.8 ± 0.3 in group B (P=0.0031). GFM-lotion was well tolerated. Conclusion: The combination of GFM-lotion containing growth factors like peptides and taurine with autologous PRP treatment is superior in term of efficacy to the treatment with PRP alone in subjects with AGA.

Efficacy of Platelet Rich Plasma and Platelet Rich Fibrin in Periodontal Regeneration: Systematic Review.

Regeneration is defined as the reproduction or reconstruction of a lost part or injury of the body in such a way that the architecture and function of the lost or injured tissue are completely restored. The goal of regenerative periodontal therapy is to restore the structure and function of the periodontium. The positive effects of Platelet-rich plasma (PRP) are attributed to the angiogenic, mitogenic and proliferative capacities of growth factors such as platelet-derived growth factor, transforming growth factor and vascular endothelial growth factor. Platelet-rich fibrin (PRF) is a second generation platelet concentrate that allows fibrin membranes enriched with platelets and growth factors to be obtained after starting an anticoagulant-free blood collection without any biomechanical artificial modification. The objective of this review is to know the efficacy of platelet-rich plasma and platelet-rich fibrin in the periodontal regeneration of intrabony defects. The clinical implications for this autologous material are promising. Further long term, larger, multicentred randomized controlled clinical trials are required to determine the effects of PRP and PRF on the regeneration of alveolar bone due to periodontal disease.

Efficacy of Platelet-Rich Plasma in Retarding Intervertebral Disc Degeneration: A Meta-Analysis of Animal Studies.

Objectives Several animal studies have demonstrated the positive effects of platelet-rich plasma (PRP) on disc degeneration retardation. The present meta-analysis was to verify the efficacy of PRP in retarding disc degeneration in animal. Methods Relevant studies were identified and evaluated according to our inclusion and exclusion criteria. The standardized mean difference (SMD) and related 95% confidence interval (95% CI) were estimated to assess PRP efficiency. Results In total, eleven studies were included in this meta-analysis. Significant differences were found in the PRP treatment group, which showed increased disc height (SMD = 2.66, 95% CI: 1.86, 3.47, p = 0.000), increased MRI T2 signal intensity (SMD = −3.29, 95% CI: −4.44, −2.13, p = 0.000), and decreased histological degeneration grade (SMD = −4.28, 95% CI: −5.26, −3.30, p = 0.000). However, no significant increase in collagen II expression was found (SMD = 25389.74, 95% CI: −27585.72, 78365.21, p = 0.348). Apart from the subgroup analysis of the disc height based on animal species (pig) and disc degeneration model (chymopapain induction), other subgroup analysis based on animal species (rabbit and rat), study design, disc degeneration model, and follow-up period demonstrated that PRP treatment can significantly restore disc height and increase MRI T2 signal intensity. Conclusions PRP treatment is potentially effective in restoring disc height of rodent rabbit and rat, reducing histological degeneration grade, and increasing MRI T2 image signal. PRP injection may be promising therapy for retarding disc degeneration.

Platelet-rich plasma increases proliferation of tendon cells by modulating Stat3 and p27 to up-regulate expression of cyclins and cyclin-dependent kinases.

To investigate effects of platelet-rich plasma on tendon cell proliferation and the underlying molecular mechanisms. Platelet-rich plasma was prepared manually by two-step centrifugation. Proliferation was evaluated in cultured rat tendon cells by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay. Cell cycle progression was assessed by flow cytometry. Messenger RNA expression of proliferating cell nuclear antigen (PCNA), cyclin E1, A2 and B1, and cyclin-dependent kinases (Cdks) 1 and 2 was assessed by real-time polymerase chain reaction. Protein expression of the above cyclins and Cdks and of signal transducer and activator of transcription (Stat) 3 and p27 was evaluated by western blotting. Platelet-rich plasma used in the present study had concentrations of platelets, TGF-β1 and PDGF over 3-fold higher than normal whole blood. Platelet-rich plasma enhanced tendon cell proliferation (P = 0.008) by promoting G1 /S phase transition in the cell cycle, and increased expression of PCNA, cyclin E1, A2 and B1, Cdks1 and 2, and phosphorylated Stat3, while inhibiting p27 expression. Platelet-rich plasma contains high concentrations of TGF-β1 and PDGF that increase tendon cell proliferation by modulating Stat3/p27(Kip1), which enhances expression of cyclin-Cdk complexes that promote cell cycle progression. These results provide molecular evidence for positive effects of platelet-rich plasma on tendon cell proliferation, which can be useful in clinical applications of tendon injury.

Effects of platelet-rich plasma on nerve regeneration in a rat model.

The aim of this study was to determine whether platelet-rich plasma has a regenerative effect on a sciatic nerve injury model in rats. A sciatic nerve cut model was created in 24 nerves of 12 rats. All nerves were repaired with epineural sutures by the same surgeon. Rats were randomly divided into two groups; platelet-rich plasma was applied to the injury site in the platelet-rich plasma group and saline only to the same area in the control group. Motor and electromyographic assessments were performed at the end of 12th postoperative week and all rats were euthanized for histological specimens. Motor recovery was significantly better in the platelet-rich plasma group than the control group. The differences in electromyographic and histomorphometric findings between the groups were significant (p<0.05). Our experimental study demonstrated positive effects of platelet-rich plasma on nerve regeneration.

USE OF PLATELET RICH PLASMA FOR THE TREATMENT OF BICIPITAL TENDINOPATHY IN SPINAL CORD INJURY: A PILOT STUDY

IntroductionShoulder pain remains one of the most common complaints in the spinal cord injury (SCI) population. Several studies suggest that approximately 30–70% of people with SCI in the USA suffer...

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exist. This review suggests that the positive effects of platelet-rich plasma were less significant in clinical trials compared with the in vitro and in vivo experimental studies; therefore, it should be highlighted that platelet-rich plasma should not be considered as the first line of treatment in clinics because there is still a lack of evidence demonstrating that the administration of plateletrich plasma is an effective method to restore the quality and integrity of the injured tissues. Conclusion Platelet-rich plasma has some beneficial effects, especially at preclinical level. Most in vitro and in vivo animal studies used allologous forms of platelet-rich plasma, and the results confirmed the efficacy of platelet-rich plasma in soft and hard connective tissue healing in different animal species. In general, platelet-rich plasma is an effective conservative treatment without the complications and cost of surgery, and with moderate success of resolving various musculoskeletal conditions; however, it should not be placed in the first line of treatment modality because it is almost effective in the short term. Future clinical trial studies should be designed to test the real efficacy of platelet-rich plasma in a more standard manner.

Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis

The aims of this study were to analyze the range of cartilage damage and patellofemoral joint (PFJ) degeneration in degenerative osteoarthritis (OA) and determine the duration for the positive effects of platelet-rich plasma (PRP) injection. This study included 65 patients suffering from OA that were treated with intra-articular PRP injection. The patients were prospectively evaluated at 1, 3, 6, 9, and 12 months after the procedure using a visual analogue scale (VAS) score and an International Knee Documentation Committee (IKDC) score. Clinical improvement in the average VAS score from 7.4 before the procedure to 4.2 at 6 months post-procedure had been reported, but the symptoms tended to deteriorate to 5.0 1 year after injection. The IKDC score also showed statistical significance (P < 0.05). Patients reported relapsed pain 8.8 months after the procedure. Developing degeneration according to the Kellgren-Lawrence grade reduced the clinical effects of PRP (P < 0.05) and also accelerated the time for feeling relapsed pain (P < 0.05). There was a statistically significant negative correlation between patient age and the PRP potential in the VAS score (slope = 0.1667) and IKDC score (slope = 1.3333). The presence of PFJ degeneration is expected to produce a worse outcome (P < 0.05). While intra-articular PRP injection can be used for the treatment of early OA, increasing age, and developing degeneration result in a decreased potential for PRP injection therapy.

The Effect of Platelet-Rich Fibrin Matrix on Rotator Cuff Tendon Healing

Background: There is a strong need for methods to improve the biological potential of rotator cuff tendon healing. Platelet-rich fibrin matrix (PRFM) allows delivery of autologous cytokines to healing tissue, and limited evidence suggests a positive effect of platelet-rich plasma on tendon biology. Purpose: To evaluate the effect of platelet-rich fibrin matrix on rotator cuff tendon healing. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Seventy-nine patients undergoing arthroscopic rotator cuff tendon repair were randomized intraoperatively to either receive PRFM at the tendon-bone interface (n = 40) or standard repair with no PRFM (n = 39). Standardized repair techniques were used for all patients. The postoperative rehabilitation protocol was the same in both groups. The primary outcome was tendon healing evaluated by ultrasound (intact vs defect at repair site) at 6 and 12 weeks. Power Doppler ultrasound was also used to evaluate vascularity in the peribursal, peritendinous, and musculotendinous and insertion site areas of the tendon and bone anchor site. Secondary outcomes included standardized shoulder outcome scales (American Shoulder and Elbow Surgeons [ASES] and L’Insalata) and strength measurements using a handheld dynamometer. Patients and the evaluator were blinded to treatment group. All patients were evaluated at minimum 1-year follow-up. A logistic regression model was used to predict outcome (healed vs defect) based on tear severity, repair type, treatment type (PRFM or control), and platelet count. Results: Overall, there were no differences in tendon-to-bone healing between the PRFM and control groups. Complete tendon-to-bone healing (intact repair) was found in 24 of 36 (67%) in the PRFM group and 25 of 31 (81%) in the control group (P = .20). There were no significant differences in healing by ultrasound between 6 and 12 weeks. There were gradual increases in ASES and L’Insalata scores over time in both groups, but there were no differences in scores between the groups. We also found no difference in vascularity in the peribursal, peritendinous, and musculotendinous areas of the tendon between groups. There were no differences in strength between groups. Platelet count had no effect on healing. Logistic regression analysis demonstrated that PRFM was a significant predictor (P = .037) for a tendon defect at 12 weeks, with an odds ratio of 5.8. Conclusion: Platelet-rich fibrin matrix applied to the tendon-bone interface at the time of rotator cuff repair had no demonstrable effect on tendon healing, tendon vascularity, manual muscle strength, or clinical rating scales. In fact, the regression analysis suggests that PRFM may have a negative effect on healing. Further study is required to evaluate the role of PRFM in rotator cuff repair.

Platelet-Rich Plasma

Several injectable substances have been studied for the treatment of tendinitis of the hand, wrist, and elbow, including corticosteroids, botulinum toxin, autologous blood, and platelet-rich plasma (PRP). 1 Faro F. Wolf J.M. Lateral epicondylitis: review and current concepts. J Hand Surg. 2007; 32A: 1271-1279 Google Scholar , 2 Mishra A. Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006; 34: 1774-1778 Crossref PubMed Scopus (628) Google Scholar , 3 Peerbooms J.C. Sluimer J. Bruijn D.J. Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010; 38: 255-262 Crossref PubMed Scopus (523) Google Scholar , 4 Szabo R.M. Steroid injection for lateral epicondylitis. J Hand Surg. 2009; 34A: 326-330 Google Scholar , 5 Creaney L. Wallace A. Curtis M. Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011; 45: 966-971 Crossref PubMed Scopus (212) Google Scholar , 6 Thanasas C. Papadimitriou G. Charalambidis C. Paraskevopoulos I. Papanikolaou A. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med. 2011; 39: 2130-2134 Crossref PubMed Scopus (262) Google Scholar , 7 Wolf J.M. Ozer K. Scott F. Gordon M.J. Williams A.E. Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg. 2011; 36A: 1269-1272 Google Scholar , 8 Gosens T. Peerbooms J.C. van Laar W. den Oudsten B.L. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011; 39: 1200-1208 Crossref PubMed Scopus (387) Google Scholar Whereas empiric data suggest a beneficial effect of many treatments for tendinitis, defined roles for these various injections remain unclear. For several years, orthopedic surgeons have used PRP to treat conditions such as tendinitis about the knee, hip, and shoulder 9 Hall M.P. Band P.A. Meislin R.J. Jazrawi L.M. Cardone D.A. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009; 17: 602-608 Crossref PubMed Scopus (273) Google Scholar , 10 Sampson S. Gerhardt M. Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008; 1: 165-174 Crossref PubMed Scopus (4) Google Scholar , 11 Mishra A. Harmon K. Woodall J. Vieira A. Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol. 2011 July 8; (Epub ahead of print) Google Scholar ; however, data are inconclusive as to its precise mechanism of action as well as whether it demonstrates lasting benefit. We review the composition and preparation of PRP and list several of the available kits for its preparation. Journal CME QuestionsJournal of Hand SurgeryVol. 37Issue 3Preview Full-Text PDF